Tips to Make Working Easier With Wet Age-Related Macular Degeneration

Listen to the article here: Age-related macular degeneration (AMD) is a progressive condition that tends to affect people later in life, but it can also appear in younger people who are still actively working. Signs of AMD are present in 14 percent of people 55 to 64 and 20 percent of those 65 to 75.

If dry AMD develops into the wet form, it can eventually cause significant vision loss, and people with the condition may wonder if they'll be able to continue working.

Wet AMD that has affected vision doesn't necessarily signal the end of one's career. While retirement or applying for disability benefits are options, experts say that many people with wet AMD who want to keep working can do so - although some strategic workplace modifications may be necessary. Of course, it depends on what kind of work you do; while certain accommodations can help office workers, people who have positions that require driving or operating heavy machinery will likely need to change jobs eventually, depending on the extent of their vision impairment.

Follow Your Wet AMD Treatment Plan

The most important thing you can do to manage wet AMD at work is to follow up with your retina specialist on the treatment schedule your doctor recommended, says Rahul N. Khurana, MD , a retina specialist at Northern California Retina Vitreous Associates in Mountain View and an associate clinical professor of ophthalmology at the University of California in San Francisco.

One of the mainstays of treatment are intraocular (into the eye) injections of antivascular endothelial growth factor, or anti-VEGF drugs, says Dr. Khurana.

If you're on anti-VEGF therapy for wet AMD, you usually need to get regular injections, which can be anywhere between every 4 weeks and every 4 months.

"Adhering to your treatment plan developed by your ophthalmologist is critical to preserving your vision and preventing vision loss, which is essential to carrying out your day-to-day tasks," Khurana says. "It's also important to follow up with your ophthalmologist and continue with your appointments. Missing or delaying follow-up visits can lead to irreversible vision loss."

Khurana also recommends using an Amsler grid to check your vision in each eye daily.

Neva Fairchild , a national aging and vision loss specialist at the American Foundation for the Blind in Arlington, Virginia, underscores that people with wet AMD should be doing "everything they can medically to control their wet macular degeneration and to stop the progression, if possible."

Seek Out a Low-Vision Specialist

In addition to monitoring your progress with your retina specialist, keeping up with treatments, and checking your vision at home, Fairchild encourages seeking out vision rehabilitation service professionals, especially a low-vision specialist - an optometrist or ophthalmologist who has more tools and tests at their disposal to help people maximize their remaining vision.

"A regular optometrist or ophthalmologist doesn't have the tools to test [your] vision if you can't see that chart that's 20 feet away down at the end of the room," Fairchild explains. "When all you see on it is a big E, it's hard to say whether lens A is any better than B."

Most urban areas or areas with large medical centers with ophthalmology services will usually offer either low-vision assistance or referrals to specialists who can provide that.

A low-vision specialist can perform a low-vision evaluation and, depending on the results, get you started with low-vision rehabilitation (more on this below).

RELATED: Use a Vision Specialist to Maximize Your Eyesight if You Have Wet AMD

Low-vision specialists can also fit you for glasses, including bifocals and contacts, according to Fairchild. If that isn't enough, the specialist can add optical aids, such as magnifying lenses , which can help you see a computer screen more clearly or see someone from a distance who's walking up to the reception desk.

In addition, some people with wet AMD like to have separate pairs of glasses for different tasks, such as reading or looking at the computer, Khurana notes.

"Low-vision devices can be very helpful for patients suffering from vision loss from macular degeneration," he says. "They allow you to maximize the vision you have to do whatever you need to do, whether that's using a computer or reading a book."

Patients with significant vision loss can benefit from a consultation with a low-vision specialist to learn which magnifying aids and devices may help them.

Occupational bifocals are an option for people like auto mechanics, who spend time looking up at the car above them and need that bifocal to be on the top part of the glasses rather than the bottom, Khurana adds.

Take Advantage of Rehabilitation Services

Your low-vision specialist may refer you to an occupational therapist or low-vision therapist for low-vision rehabilitation to maximize your vision and efficiently use your remaining eyesight. A therapist can teach you strategies and techniques to help you accomplish everyday tasks more easily and might introduce you to assistive technology and devices .

"When optical aids aren't enough, then there are electronic aids," Fairchild says. A portable electronic magnifier, which looks like an iPad or tablet device, is one option. You simply hold the device in front of whatever you're trying to read, and the magnified version appears on the LED screen, according to the American Academy of Ophthalmology (AAO).

Another option is a video magnifier. A camera transmits magnified video images (up to 50x or higher) and displays them on a large monitor or TV screen.

A low-vision therapist can teach you adaptive skills to help you live and work as independently as possible. They can even visit your workplace and your home to determine what kinds of environmental modifications and adaptive ways of doing things will benefit you.

Depending on your needs, you might also consider working with an orientation and mobility specialist. They can help you relearn how to move around - indoors, outdoors, and on public transportation - safely.

"A good conversation with a low-vision therapist, vocational rehabilitation counselor, or vision rehabilitation therapist can help a person hope again - help them dream again," Fairchild says.

RELATED: Low-Vision Apps, Devices, and Virtual Assistants Can Expand Your View

Workplace Modifications That Can Help

People with wet AMD are entitled to "reasonable accommodations" from their employer, according to the Americans with Disabilities Act .

These may include assistive technologies (magnifiers, scanners, software that reads information on your computer screen), training in the use of assistive technologies, and time off, if needed.

Here are six workplace modifications to consider:

1. Get the light right. Overhead lighting isn't usually enough for people with wet AMD, according to Fairchild. Depending on what works best for you, she says, "You may have to add either brighter or higher wattage bulbs above you or next to you on your desk."
2. Try a larger computer monitor. If you use a computer at work, "most of the time a larger viewing surface helps," Fairchild notes. A 32-inch monitor is often adequate, but you should test out different sizes to see what works best for you, she advises. Controlling glare on the monitor is also essential when trying to maximize your usable vision. "A way to control that light is with blinds, glare control [screen covers], sunglasses, or sun shields that you wear indoors," Fairchild says.
3. Pay attention to ergonomics. "Cranking your head up and back to see the top of the screen or leaning way in to get close to a screen is not good for your body," Fairchild says. "It strains your neck and strains your back, and it's going to eventually deteriorate your overall well-being." She recommends using a monitor arm that allows you to bring the screen closer to you, so you don't have to lean in over your desk.
4. Learn to type by touch. If you don't have to look at the keyboard to type, you'll reduce eyestrain. Haven't learned this skill yet? It'll be worth the effort. Typing without looking at the keyboard will be easier and faster than using voice-to-text technology, according to Fairchild. "With the people with low vision that I've worked with over the years, if they learn the keyboard by touch, they can input information into the computer more accurately and faster with their fingers than they can with their voice and [then] go back to fix the issues," she says. You can also use a large-print keyboard.
5. Use a magnifier. Closed-circuit television, desktop, and handheld magnifiers are available in a range of strengths. They can make it easier for people with low vision to see books and other things. "Sometimes [CCTV magnifiers] can be combined with your computer monitor, so you don't have to have two huge monitors on your desk," Fairchild adds.
6. Lean on large print and colors. Large print, large labels, and color-coding systems can be an effective way to help you organize paperwork, filing systems, schedules, and more. In addition, personalizing the settings on your computer can be helpful, Khurana says. He recommends experimenting with the background color, type size, font, and color to find the optimal combination that allows you to see what's on the screen.

Stay Connected: Resources and Support

If you're newly diagnosed with wet AMD, you may not realize how many resources are available to help you do your job, even if you no longer have full vision. Fairchild emphasizes how important it is to find accurate information.

In addition to seeking out vision rehabilitation professionals, she recommends reading about visual impairments and treatments online at VisionAware and the Foundation Fighting Blindness . She also suggests checking out talking book programs at places like the Library of Congress . Many local libraries now offer audiobooks on loan, as well.

Getting connected with others who know what you're going through can also make a difference, Fairchild says. Find them through organizations lioke the American Council of the Blind , National Federation of the Blind , Eye2Eye Peer Support Program , and the BrightFocus Foundation .

And remember, if you want to keep working, you can likely find a way. "That's the thing that so many people who are losing vision don't realize," she says. "You might have to do it differently, but it's still doable. There are very few jobs that - with the right motivation, the right skills, and the right training - a person with low vision or no vision can't do."

If, on the other hand, you decide that you don't want to continue working due to wet AMD, then Fairchild says the sooner you apply for disability insurance the better, because if they award it to you, they'll give you back pay to the date you applied. "The other thing," she says, "is that if you're turned down the first time, appeal, appeal, appeal."

More in Wet AMD

The Consumer's Guide to Anti-VEGF Treatments for Wet AMD

5 Ways to Get to and From Your Wet AMD Eye Appointments

5 Wet Macular Degeneration Myths, Debunked

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Sources

1. Age-Related Macular Degeneration. UCI Gavin Herbert Eye Institute.